| NPI | 1700857729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-4771) |
| Additional Taxonomies | 174400000X Specialist (Licence: ID M4771) |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2012-05-31 |