| NPI | 1174670863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME97155) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD29002) |
| 207Q00000X Family Medicine (Licence: CA A97677) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2013-07-08 |