| NPI | 1235287301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-4046) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 24913) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |