| NPI | 1346405362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 55667-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R8400) |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2016-09-15 |