| NPI | 1093079345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS13593) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 4403) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2015-10-07 |