| NPI | 1215279849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 24333) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MD 8356) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2016-02-16 |