| NPI | 1801025630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 005940) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR LL18366) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2016-01-27 |