| NPI | 1205820396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-44988) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 36625) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2018-06-14 |