| NPI | 1548581390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-1113) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2013-11-12 |