| NPI | 1336112788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.16116) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 13276) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2018-11-05 |