| NPI | 1689888489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101241697) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 042750) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2007-11-07 |