| NPI | 1982668190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 024314) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 24314) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2015-06-19 |