| NPI | 1790948669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 699) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2016-06-21 |