| NPI | 1134255789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0076832) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2005-01898) |
| 207Q00000X Family Medicine (Licence: NH 14188) | |
| 207Q00000X Family Medicine (Licence: LA MD.202899) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2014-06-12 |