| NPI | 1912099169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2009-0099) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 015190) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2014-01-24 |