| NPI | 1386899292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301093962) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9601201) |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2013-12-17 |