| NPI | 1154439339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301058995) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302410956) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2011-05-10 |