| NPI | 1124137088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS21088) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS009083L) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2025-03-24 |