| NPI | 1134431349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 1.053735) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 0) |
| 207Q00000X Family Medicine (Licence: SC TL35309) | |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2020-09-16 |