| NPI | 1588898712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D77769) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 45779) |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2015-09-25 |