| NPI | 1881847689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME121200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD30120) |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2015-02-16 |