| NPI | 1386650406 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS 10119) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2006018040) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2008-08-08 |