| NPI | 1568570653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD202004) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 14928) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2015-07-28 |