| NPI | 1992840292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 061675) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301406615) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2014-04-29 |