| NPI | 1023048626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-03851) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101015800) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2018-10-16 |