| NPI | 1265645220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 3429) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 562) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2018-08-19 |