| NPI | 1023278116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD29939) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 48696) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2018-07-06 |