| NPI | 1952417248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 3864) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA DO-R-8208) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2015-11-18 |