| NPI | 1194709238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME113171) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 26405) |
| 207Q00000X Family Medicine (Licence: AZ 30620) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2013-03-07 |