| NPI | 1821136136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 13970) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 13970) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2019-04-25 |