| NPI | 1316140783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2010019761) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301090151) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2013-01-21 |