| NPI | 1962893370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 5906) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 18581) |
| Enumeration Date | 2015-02-08 |
| Last Update Date | 2015-02-08 |