| NPI | 1609087980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL UO 1491) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS 10299) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2008-02-22 |