| NPI | 1952339533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 08979R) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 08979R) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2018-06-05 |