| NPI | 1609870948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 38558) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD SD5550) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2013-12-17 |