| NPI | 1003171901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12953) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116025236) |
| Enumeration Date | 2012-07-07 |
| Last Update Date | 2020-09-14 |