| NPI | 1780795898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 32302) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 20182) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-12-17 |