| NPI | 1114238250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12316) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OTO13707) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2022-07-21 |