| NPI | 1750618674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0101043292) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: IA 17826) |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2009-11-13 |