| NPI | 1639141666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 25563) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 1981-25563) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2015-03-10 |