| NPI | 1649286386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA IA3729) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 3729) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2012-01-06 |