| NPI | 1891772786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2008014963) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E2759) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2014-07-21 |