| NPI | 1003336777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 59791) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 1908R76442) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2024-11-19 |