| NPI | 1518916683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.201171) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 201171) |
| 207Q00000X Family Medicine (Licence: PR 12936) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2010-09-02 |