| NPI | 1659592202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 1330) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4556) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2011-01-05 |