| NPI | 1972540870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0894) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO26572) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2016-06-23 |