| NPI | 1497788053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: MA 49807) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 49807) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2015-11-06 |