| NPI | 1427220383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL LL824) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 6966) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2019-05-15 |