| NPI | 1861621211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0075059) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 003727) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2013-01-31 |