| NPI | 1821048059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 24264) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 31710) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2010-09-20 |