| NPI | 1669895223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL L3510R) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 118521) |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2014-01-31 |