| NPI | 1144432402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12134) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101016675) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2014-11-06 |