| NPI | 1992738926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 8688) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 00008688) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2013-07-16 |