| NPI | 1881850907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 7177) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 5885) |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2017-11-15 |