| NPI | 1700062494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS10614) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS014320) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2013-09-19 |