| NPI | 1083828610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 005287) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101016961) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2019-04-22 |