| NPI | 1497062558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 4453) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2010024515) |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2019-09-19 |