| NPI | 1023099181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 22424) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 0022424) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2015-03-05 |