| NPI | 1881818615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301095854) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101241384) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2011-12-16 |