| NPI | 1821135690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR C6251) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R2G30) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2013-04-24 |