| NPI | 1366726358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D0014870) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MD D0014870) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: MD DOO14870) | |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2011-10-07 |