| NPI | 1831172451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 108455) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301070810) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2014-11-12 |