| NPI | 1780781591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15063) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD H63003) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-05-22 |