| NPI | 1861653404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D72318) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2010-01890) |
| 207Q00000X Family Medicine (Licence: NC 149428) | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2015-04-01 |