| NPI | 1689652356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.014217) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 014217) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2014-06-19 |