| NPI | 1114010006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 006095) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS006293L) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2019-09-04 |