| NPI | 1952656001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.33596) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL L3461.R) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2015-06-28 |