| NPI | 1881739076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0689) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO158157) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2016-11-09 |