| NPI | 1558548826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS 006701E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK AA1562) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2009-07-08 |