| NPI | 1669588315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0870) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 5960250-1204) |
| 207Q00000X Family Medicine (Licence: OR DO27594) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2016-11-10 |