| NPI | 1750503041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 28359) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL L-2810) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2013-03-25 |