| NPI | 1942380431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 24769) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 7915A) |
| 207Q00000X Family Medicine (Licence: CO 2119) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2012-04-04 |