| NPI | 1134358518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 25917) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6163) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2022-07-11 |