| NPI | 1194010389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME119870) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN16060) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2014-12-24 |