| NPI | 1770752206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 1435) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL os5369) |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2008-02-28 |