| NPI | 1912285867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 12922) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL11856) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2014-07-16 |