| NPI | 1780686949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 53448) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME100183) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2017-10-17 |