| NPI | 1316264724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 006156) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R9129) |
| Enumeration Date | 2010-04-24 |
| Last Update Date | 2013-12-02 |