| NPI | 1285981621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD 00056620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0202045772) |
| 207Q00000X Family Medicine (Licence: UT 156636-1205) | |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2012-08-03 |