| NPI | 1851473581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS 6879) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS0006879) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2010-09-23 |