| NPI | 1215248927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 69392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS12087) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2018-06-06 |