| NPI | 1003158171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301103228) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MI 4301103228) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2017-01-05 |