| NPI | 1245320480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 46201) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 28814) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2012-01-12 |