| NPI | 1184679573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D28625) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0028625) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2010-04-14 |