| NPI | 1124113006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 012046) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 19182) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |