| NPI | 1295828127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C20004996) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C2-0004996) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2010-12-22 |