| NPI | 1598962821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 16553) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: PR 16553) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2016-06-20 |