| NPI | 1396718128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS11273) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS003486L) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2017-05-24 |