| NPI | 1891787578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 37534) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 055797) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2015-10-19 |