| NPI | 1245449099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO28614) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR LL16276) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2013-04-12 |