| NPI | 1457317489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL FLOS6107) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL FLOS6107) |
| 208000000X Pediatrics (Licence: FL FLOS6107) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2009-12-16 |