| NPI | 1295823813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 058379) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 200890) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2011-12-09 |