| NPI | 1821087800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-02331) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 43555) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2016-03-23 |