| NPI | 1134249501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-01868) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL28976) |
| 207Q00000X Family Medicine (Licence: WI 52790) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2019-02-18 |