| NPI | 1801121215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME46383) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 16884) |
| 207Q00000X Family Medicine (Licence: SC 7325) | |
| Enumeration Date | 2009-10-03 |
| Last Update Date | 2009-10-03 |