| NPI | 1346200359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200201241) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 39880) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2017-05-12 |