| NPI | 1780606814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI GT007643) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4503) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2008-03-06 |