| NPI | 1134168859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 13517) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301084608) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2014-11-26 |