| NPI | 1447240742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 201402290) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 041076) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2019-08-01 |