| NPI | 1841253036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 34742) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 96-44) |
| Enumeration Date | 2006-04-09 |
| Last Update Date | 2007-07-09 |