| NPI | 1912979592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 06296) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 00007236) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2010-01-19 |