| NPI | 1346341021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-10078) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 7553A) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2009-02-17 |