| NPI | 1891820692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301083017) |
| 207Q00000X Family Medicine (Licence: GU M001507) | |
| 207Q00000X Family Medicine (Licence: IN 01034877A) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-07-09 |