| NPI | 1538130109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 21930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 11352) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2016-06-14 |