| NPI | 1992790745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 180047) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2005-00315) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2015-01-21 |