| NPI | 1952317018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 230303) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301081966) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2013-05-06 |