| NPI | 1467458844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 23450) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 21148) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2010-09-13 |