| NPI | 1699056101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 006273) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO2731) |
| 207Q00000X Family Medicine (Licence: FL OS11891) | |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2014-10-24 |