| NPI | 1770659575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 864) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101005787) |
| 207Q00000X Family Medicine (Licence: MO DO31497) | |
| 207Q00000X Family Medicine (Licence: FL OS2949) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2007-07-08 |