| NPI | 1750676342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 61767) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL11951) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2016-06-21 |