| NPI | 1063421683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 47066) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101014920) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2016-05-09 |