| NPI | 1346384773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 59630) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2007-00142) |
| Enumeration Date | 2007-02-18 |
| Last Update Date | 2011-01-09 |