| NPI | 1760484158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS6577) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: FL OS6577) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2014-03-20 |