| NPI | 1831186295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 29899-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301055360) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2012-07-20 |