| NPI | 1881618411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS8070) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL OS8070) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2011-08-17 |