| NPI | 1881607026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: PR 13723) |
| Additional Taxonomies | 282NC0060X General Acute Care Hospital Critical Access (Licence: PR 13723) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2016-05-03 |