| NPI | 1912078346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS5362) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS002978L) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2014-12-06 |