| NPI | 1598807547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301087633) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301087633) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2016-08-16 |