| NPI | 1861561094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M7337) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2011020656) |
| 207Q00000X Family Medicine (Licence: TN 46233) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2011-12-15 |