| NPI | 1811923808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL OS3875) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS0003875) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2014-04-25 |