| NPI | 1811181761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 37243) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-14452) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2014-03-28 |