| NPI | 1265467559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301068879) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 16573) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2018-06-25 |