| NPI | 1639281116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 34955) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR R3512) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-09 |