| NPI | 1982017786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2017018127) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2014017191) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2018-03-17 |