| NPI | 1992735351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 28871-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI DD406638) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2010-02-26 |