| NPI | 1154700771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 38240) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL38240) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2018-08-13 |