| NPI | 1689659708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12005) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 37204) |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2019-11-25 |