| NPI | 1790722643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 40999) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 27695) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2015-12-08 |