| NPI | 1699804690 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 34759) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 037100) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2018-08-03 |