| NPI | 1972531127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 13953) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 09300) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2016-05-05 |