| NPI | 1902078223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 9227) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 9227) |
| 208D00000X General Practice (Licence: NC 9600535) | |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2017-04-03 |