| NPI | 1013321546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 36928) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL36928) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2020-11-11 |