| NPI | 1881668390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.016826) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 016826) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2016-03-11 |