| NPI | 1932145919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 5903993-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35070989) |
| 207Q00000X Family Medicine (Licence: CA A86934) | |
| 207Q00000X Family Medicine (Licence: PA MD069573L) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2016-01-22 |