| NPI | 1538133905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 029476) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 29476) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2019-08-21 |