| NPI | 1932276961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD152897) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 32399) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2019-10-29 |