| NPI | 1013001189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 17025) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: MS 17025) |
| 208D00000X General Practice (Licence: MS 17025) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-02-12 |