| NPI | 1225042864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS13123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS8585) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2018-10-13 |