| NPI | 1104848977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 024386) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 16029) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2010-07-18 |