| NPI | 1902048226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.31240) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 31240) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2022-01-05 |