| NPI | 1760714380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 45692) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 003975) |
| Enumeration Date | 2010-02-06 |
| Last Update Date | 2015-07-20 |