| NPI | 1194724245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 028848) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 22677) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2019-10-16 |