| NPI | 1801897269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 00013653) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-8671) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2009-11-17 |