| NPI | 1174834246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0647) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO164436) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2019-12-03 |