| NPI | 1205044146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2007018127) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2006017939) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2018-09-26 |