| NPI | 1881745339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 027231) |
| Additional Taxonomies | 207QB0002X Family Medicine, Bariatric Medicine (Licence: CT 027231) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2012-11-14 |