| NPI | 1700053444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2014005002) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 060849) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2014-08-06 |