| NPI | 1275598120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0023774) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 11172) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2016-09-27 |