| NPI | 1649230913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NC 24534) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 24534) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2013-12-04 |