| NPI | 1982866679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD187005) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 73767701205) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2018-04-30 |