| NPI | 1831488972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME111817) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN15330) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2013-05-21 |