| NPI | 1235181504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 8121) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID O-0396) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2020-10-21 |