| NPI | 1932365533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-11390) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301092447) |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2014-02-04 |