| NPI | 1053520403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 37367) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 26013) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2010-10-21 |