| NPI | 1053591149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 12569) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD431130) |
| 207Q00000X Family Medicine (Licence: AZ 37401) | |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2019-03-22 |