| NPI | 1578527990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M5758) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 29273) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2017-02-09 |