| NPI | 1457504540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME76530) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-15513) |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2008-11-03 |