| NPI | 1023372612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 16237) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301101427) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2016-06-23 |