| NPI | 1134385461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD155468) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN12110) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2011-09-22 |