| NPI | 1508025594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 049851) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CT 049851) |
| 208D00000X General Practice (Licence: CT 049851) | |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2020-12-11 |