| NPI | 1497899314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 29385) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2008-0513) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2009-03-27 |