| NPI | 1760456362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 077414) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 38109-020) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2017-06-01 |