| NPI | 1851392195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101011930) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101011930) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2016-07-22 |