| NPI | 1093700296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: AZ 3813) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 3813) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2022-07-21 |