| NPI | 1215298344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 264795) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60293491) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2015-10-02 |