| NPI | 1083062632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL F6607968938880) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2019-08-20 |