| NPI | 1639212269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301047679) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301047679) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2014-07-10 |