| NPI | 1659549103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 049938) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME79396) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2008-02-19 |