| NPI | 1043434525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 5484) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-38295) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2020-05-27 |