| NPI | 1659471555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 32113) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME92937) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2017-02-03 |