| NPI | 1942440052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 609) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 31141) |
| Enumeration Date | 2009-03-02 |
| Last Update Date | 2012-04-03 |