| NPI | 1003007048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 37515) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0066324) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2017-01-26 |