| NPI | 1285802876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 7306) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: AL 7306) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2016-02-19 |