| NPI | 1508128810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-38374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R73425) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2016-03-31 |