| NPI | 1699787556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301113708) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 13373) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2019-01-30 |