| NPI | 1760712053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD06491R) |
| Additional Taxonomies | 208U00000X Clinical Pharmacology (Licence: LA MD.06491R) |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2013-08-01 |