| NPI | 1124016605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 0S8814) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL os8814) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2018-04-23 |