| NPI | 1063497386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301070441) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301070441) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2013-07-10 |