| NPI | 1437595998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME113412) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 7256) |
| 207Q00000X Family Medicine (Licence: TN 35498) | |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2013-05-10 |