| NPI | 1447411145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2011011353) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL trn12304) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2012-12-04 |