| NPI | 1760618003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.31878) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301094275) |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2018-07-26 |