| NPI | 1366447260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301085080) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 10440) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2010-01-11 |