| NPI | 1447250170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 044797) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC 22055) |
| 207Q00000X Family Medicine (Licence: MS 15154) | |
| 207Q00000X Family Medicine (Licence: NC 9701830) | |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2020-03-30 |