| NPI | 1548286206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 19748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101259223) |
| 207Q00000X Family Medicine (Licence: IN 010691498A) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2018-03-17 |