| NPI | 1770584989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 006092) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A7881) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2015-01-07 |