| NPI | 1730310830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD181082) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6135) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2017-06-07 |