| NPI | 1275556854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0053675) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C10006525) |
| 207Q00000X Family Medicine (Licence: DE C1-0006525) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2021-05-18 |