| NPI | 1548442106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO MDR4G28) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301050425) |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2007-12-05 |