| NPI | 1184651770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 273556) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 52721) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2014-10-10 |