| NPI | 1477865764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2013-0742) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2010-0414) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2013-08-29 |