| NPI | 1114331154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 37072) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL37072) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2023-05-11 |