| NPI | 1235138751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 6167776-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101014857) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2013-04-29 |