| NPI | 1750442166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 19128) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 052573) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2019-03-26 |