| NPI | 1972570547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2004-00115) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200400115) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2012-06-19 |