| NPI | 1144361411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 26458) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 026458) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2021-07-12 |