| NPI | 1689601700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 95-23) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM 9523) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2017-03-09 |