| NPI | 1194862433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 15942) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 20764) |
| 207Q00000X Family Medicine (Licence: MN 22229) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2009-04-02 |