| NPI | 1730155128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301099774) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 035819) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2014-01-17 |