| NPI | 1891950457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 71544) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 46219) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2016-03-01 |