| NPI | 1710188032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD18963) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M8925) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2014-04-21 |