| NPI | 1477999282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-9865) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 18719) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2016-10-10 |