| NPI | 1700086048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME121101) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301086364) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2016-01-13 |