| NPI | 1447577317 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 40859) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 64000) |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2015-12-03 |