| NPI | 1962643478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 38630) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL L.3021R) |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2014-05-08 |