| NPI | 1760423339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 12896) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 13844) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2015-09-15 |