| NPI | 1700049525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D72840) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MD D72840) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2011-10-09 |