| NPI | 1053753137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12842) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 008586) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2022-06-14 |