| NPI | 1649556150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: AR C3190) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AR C3190) |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2011-10-28 |