| NPI | 1043250327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 9782) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 022796) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2019-04-08 |