| NPI | 1831134352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 28574-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 28574) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2018-06-06 |