| NPI | 1982156964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME89105) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 13146) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2016-10-26 |