| NPI | 1083706758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 14130) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 00014130) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2018-05-24 |