| NPI | 1568465797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 9599A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 018322) |
| 207Q00000X Family Medicine (Licence: LA MD.018322) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2015-08-14 |