| NPI | 1528207156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 7326) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 37093) |
| 207Q00000X Family Medicine (Licence: WA MD00048363) | |
| 207Q00000X Family Medicine (Licence: ID M-9986) | |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2012-12-03 |