| NPI | 1487746483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 042868) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA GA 042868) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2009-12-08 |