| NPI | 1861463689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 10343) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 3810) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2017-04-19 |