| NPI | 1780613455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X (Licence: SC 20284) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: SC 20284) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-04-06 |