| NPI | 1437195245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 48143-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 11073) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2012-03-15 |