| NPI | 1942233705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 029887) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 13647) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-07-08 |