| NPI | 1316055320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: ID M4937) |
| Additional Taxonomies | 207QA0000X Family Medicine Adolescent Medicine (Licence: ID M4937) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2016-01-18 |