| NPI | 1396971115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 59997-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 39079) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2013-02-18 |