| NPI | 1851350052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2009017627) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 31623) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2012-09-12 |