| NPI | 1144473661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.30177) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL L.3089R) |
| 207Q00000X Family Medicine (Licence: TX N9733) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2012-04-17 |