| NPI | 1386667152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 58820) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS9604) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2010-02-18 |