| NPI | 1528152139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI EC010429) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101010429) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2019-03-25 |