| NPI | 1205948247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R8G07) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E4127) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-09-11 |