| NPI | 1609072081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2010-0767) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2007-0381) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2015-12-07 |