| NPI | 1962692707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 7791) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND TRL10557) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2011-11-29 |