| NPI | 1548482995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.28677) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 63543) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2021-09-23 |