| NPI | 1205823762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 33205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4310075257) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2018-12-31 |