| NPI | 1043272339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 23064) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 19853) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2011-12-20 |