| NPI | 1912972530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 31289) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS6933) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2015-10-21 |