| NPI | 1447456686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID MR0936) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR 0936) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2020-09-16 |