| NPI | 1497857726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 21172) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 131910) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2015-10-20 |