| NPI | 1861590986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 11686) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 924) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-05-06 |