| NPI | 1548335730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 24245) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 24245) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2016-10-20 |