| NPI | 1902009269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 43489) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-6608) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2013-11-27 |