| NPI | 1689864951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2009-0771) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 2007-0423) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2011-01-17 |