| NPI | 1053313452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 31722) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 42670) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2013-09-25 |