| NPI | 1942313572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 061856) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 22858) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2015-06-09 |