| NPI | 1366441552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS 12653) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 00663) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2014-08-19 |