| NPI | 1831327667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 761) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6033) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2012-11-08 |