| NPI | 1043357916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 2292) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102050050) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2014-04-04 |