| NPI | 1679750541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 7755A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 41253) |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2010-06-30 |