| NPI | 1003027939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 38928) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 24765) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2021-10-14 |