| NPI | 1508942137 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 19114) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS MS19114) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2019-04-17 |