| NPI | 1780629568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7429793-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 11327) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2009-11-05 |