| NPI | 1659540573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 8865) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 5131) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2008-02-25 |