| NPI | 1629266937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 064350) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 29973) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2020-02-19 |