| NPI | 1891074803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 41854) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 28025) |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2014-09-08 |