| NPI | 1831593896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-5085) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 45153) |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2014-10-20 |