| NPI | 1194774646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR R-4722) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX D7542) |
| 207Q00000X Family Medicine (Licence: AR R-4722) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2017-01-13 |