| NPI | 1043493943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 05127) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A10130) |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2024-02-28 |