| NPI | 1104963156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI DP008207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI DP008207) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2014-06-25 |