| NPI | 1568521516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-01670) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101238988) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2013-02-01 |