| NPI | 1073967238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 25833) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL L.4157R) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2018-06-18 |