| NPI | 1366433310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 33974) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 44941) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2014-08-19 |