| NPI | 1326377573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 267508) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 60 282836) |
| 207Q00000X Family Medicine (Licence: IN 01071528A) | |
| 207Q00000X Family Medicine (Licence: AL L.3074R) | |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2017-12-09 |