| NPI | 1396773024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.29351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 058432) |
| 207Q00000X Family Medicine (Licence: LA MD200895) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2016-10-24 |