| NPI | 1033189469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 86715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 0078718) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2022-01-28 |