| NPI | 1497950315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME105604) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: FL ME105604) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME105604) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2012-10-03 |