| NPI | 1528259397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 54108-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2007012349) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2012-03-28 |