| NPI | 1083743249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2009-01475) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 134282) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2021-07-15 |