| NPI | 1184037020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS13490) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO 3884) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2016-05-04 |