| NPI | 1598744054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 21158) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 32405) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2010-11-18 |