| NPI | 1841686029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2017030003) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 05232) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2018-12-18 |