| NPI | 1043287329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 079133) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101010869) |
| Enumeration Date | 2006-03-05 |
| Last Update Date | 2018-12-14 |