| NPI | 1104051770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12713) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS014457) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2023-03-15 |