| NPI | 1427165851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 37151) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 15993) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2012-04-25 |