| NPI | 1043430606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5315027830) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 063099) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2016-12-01 |