| NPI | 1932125291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134780) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 057979) |
| 3416L0300X Ambulance, Land Transport (Licence: GA 001-03) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-08-27 |