| NPI | 1336189075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 37092) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: MI 4301089159) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2018-05-31 |