| NPI | 1871989244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 310182) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA GETP.201476) |
| Enumeration Date | 2015-04-12 |
| Last Update Date | 2018-07-31 |