| NPI | 1386889574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS10913) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS014565) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2011-03-18 |