| NPI | 1245486521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102036835) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101012928) |
| 207Q00000X Family Medicine (Licence: DC DO31529) | |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2008-08-18 |