| NPI | 1588681084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 17719) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M6300) |
| 207Q00000X Family Medicine (Licence: HI 1420) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2018-07-27 |