| NPI | 1891936522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.012014) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL DO 1068) |
| 207Q00000X Family Medicine (Licence: PA OS014787) | |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2016-02-09 |