| NPI | 1801952494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 28970) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 26775) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2014-01-29 |