| NPI | 1740474154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 62926) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM Md2009-0144) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2012-01-20 |