| NPI | 1558599159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 31723) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 067559) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2012-06-22 |