| NPI | 1437307030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS10588) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 56632-21) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2017-05-04 |