| NPI | 1881895860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 51586) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 061201) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2019-12-12 |