| NPI | 1568759645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.37441) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 7767) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2018-09-12 |