| NPI | 1750606042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2013033410) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-36367) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2013-09-10 |