| NPI | 1972529014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301063893) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI RR063893) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2012-02-06 |