| NPI | 1629286075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.204623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA PGY.2-LSUNO) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2013-06-11 |