| NPI | 1609808583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS5319) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL os7319) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2019-10-01 |