| NPI | 1154552990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 069369) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 273068-1) |
| 207Q00000X Family Medicine (Licence: AL 34824) | |
| 207Q00000X Family Medicine (Licence: KS 04-34527) | |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2019-12-03 |