| NPI | 1396970950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME113498) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 27027) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2016-12-15 |