| NPI | 1861494866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301078206) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 45131-020) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2007-11-26 |