| NPI | 1932391661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD32274) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 32274) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2021-05-26 |