| NPI | 1386731065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 12588) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 2477) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2018-04-25 |