| NPI | 1386956746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 70398) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301097370) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2019-12-05 |