| NPI | 1720267891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 057558) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 14848) |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2011-09-19 |