| NPI | 1073832044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD d0070134) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101246824) |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2023-12-04 |