| NPI | 1093928004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 52599-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 37280) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2019-01-29 |