| NPI | 1932462090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-00991) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 22933) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2015-11-23 |