| NPI | 1093761785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 38995) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 03120) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2009-09-17 |