| NPI | 1063821759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS13646) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME DO3529) |
| 207Q00000X Family Medicine (Licence: TX S9502) | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2024-01-11 |