| NPI | 1528293933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2011-01716) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 157174) |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2012-10-10 |