| NPI | 1477541712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM A-1596-11) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4479) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2014-10-06 |