| NPI | 1871520023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA R4173) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 4173R) |
| 207Q00000X Family Medicine (Licence: AR C5365) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2010-05-18 |