| NPI | 1336496272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 121584) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: GA 73055) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2016-03-08 |