| NPI | 1528088648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 36103) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 036103) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2019-05-15 |