| NPI | 1770554446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 055684) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D59153) |
| 207Q00000X Family Medicine (Licence: AL MD.25727) | |
| 207Q00000X Family Medicine (Licence: MO 2002029292) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2016-04-13 |