| NPI | 1891746061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101243031) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301080126) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2015-09-28 |