| NPI | 1598737033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD158348) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 36137) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2013-03-13 |