| NPI | 1730112244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301084203) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME97694) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2007-07-08 |