| NPI | 1285677732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2001000305) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-22847) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2018-08-30 |