| NPI | 1477596609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 6912) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 7143502-1205) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2014-10-14 |