| NPI | 1588778591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 00017633) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 037931) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2012-09-28 |