| NPI | 1215323639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-12387) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.37509) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2019-06-26 |