| NPI | 1518999473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 25907-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME46677) |
| 207Q00000X Family Medicine (Licence: AR C-5843) | |
| 207Q00000X Family Medicine (Licence: OK 23393) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2017-01-23 |