| NPI | 1235358607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12615) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL DO 309) |
| 207Q00000X Family Medicine (Licence: HI DOS-943) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2019-10-18 |