| NPI | 1659402782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-00350) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI H10902) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2015-09-21 |