| NPI | 1871776732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 16934) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ACN751) |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2020-08-04 |