| NPI | 1790882801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 0S3207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS0003207) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2017-03-23 |