| NPI | 1952594384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R1J36) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 440) |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2010-01-11 |