| NPI | 1245431550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2009002140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2006019746) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2014-09-08 |