| NPI | 1962415000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 26848) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2009-00027) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2016-06-28 |