| NPI | 1619935442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 43909) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 19021) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2011-04-27 |