| NPI | 1164699310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0074827) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.204607) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2016-08-23 |