| NPI | 1639178114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QA0005X Clinic/Center Ambulatory Family Planning Facility (Licence: OR 44) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD15808) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2019-04-10 |