| NPI | 1639229040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 99-332) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 4269) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2007-07-08 |