| NPI | 1730528803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A145352) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0075267) |
| 207Q00000X Family Medicine (Licence: MD D75267) | |
| 207Q00000X Family Medicine (Licence: DE C10011721) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2017-10-18 |