| NPI | 1265452379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.15271) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01069653A) |
| 207Q00000X Family Medicine (Licence: NC 38828) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2019-09-12 |