| NPI | 1457568685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12346) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 44001) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2019-09-23 |