| NPI | 1730318346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.207287) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T-2259) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2015-04-24 |