| NPI | 1992901268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 37894) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R8109) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2010-08-24 |