| NPI | 1972778892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.28475) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 47932) |
| 207Q00000X Family Medicine (Licence: AK 6934) | |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2010-11-09 |