| NPI | 1427187632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2015-0003) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NM MD2015-003) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2019-08-26 |