| NPI | 1518937101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX l6617) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX L6617) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2019-03-25 |