| NPI | 1740593862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0735) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101018756) |
| Enumeration Date | 2010-07-18 |
| Last Update Date | 2013-08-01 |