| NPI | 1912044579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 1097) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 0S002787L) |
| 207Q00000X Family Medicine (Licence: CA 20A 3308) | |
| 207Q00000X Family Medicine (Licence: CA 20A3308) | |
| 207Q00000X Family Medicine (Licence: PA OS002787L) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2010-05-06 |