| NPI | 1578549085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME68880) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.30109) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2012-08-01 |