| NPI | 1982048146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.36771) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 52868) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2018-03-17 |