| NPI | 1851772289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2016033286) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2015017297) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2018-07-03 |