| NPI | 1952309833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2011-0630) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301082611) |
| 207Q00000X Family Medicine (Licence: WI 45881) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2011-08-30 |