| NPI | 1982990214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2014011573) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2011018665) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2014-07-16 |