| NPI | 1710173968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS 10858) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO 1671) |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2014-05-22 |