| NPI | 1609866334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS6553) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102203148) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2019-07-15 |