| NPI | 1447258215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 24003) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 049855) |
| 291U00000X Clinical Medical Laboratory (Licence: AL 01D0985382) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2019-02-22 |