| NPI | 1679574487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-3318) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD22352) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2008-03-19 |