| NPI | 1710155627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MI 4301o24966) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301024966) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2008-02-13 |