| NPI | 1669780433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 19773) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2010019750) |
| 207Q00000X Family Medicine (Licence: OR DO159859) | |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2015-11-20 |