| NPI | 1962469395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 365) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 7261660-1204) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2010-05-04 |