| NPI | 1952424301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MI 5101016342) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MA 249578) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2012-12-26 |