| NPI | 1134432545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12290) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2011025965) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2021-03-29 |