| NPI | 1467491266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MS 21492) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 056998) |
| 207Q00000X Family Medicine (Licence: PA OS008848L) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2011-06-17 |