| NPI | 1558623447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GU M1930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101255199) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2016-04-06 |