| NPI | 1265495774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI 13281) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301080614) |
| 207Q00000X Family Medicine (Licence: AZ 34641) | |
| 213E00000X Podiatrist (Licence: CA E3300) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2009-09-23 |