| NPI | 1164427910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA os004520l) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 193400000x) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2016-09-19 |