| NPI | 1588088785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: OR MD7593) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: OR MD07593) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2014-02-07 |