| NPI | 1053384503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 22268) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 27083) |
| 207Q00000X Family Medicine (Licence: IN 01028683A) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2009-10-22 |