| NPI | 1649610080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301103718) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5315061522) |
| Enumeration Date | 2013-06-30 |
| Last Update Date | 2013-06-30 |