| NPI | 1831109933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: HI 14141) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101232571) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2015-07-08 |