| NPI | 1144253071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 005838) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 005838) |
| 207Q00000X Family Medicine (Licence: FL OS 7045) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2023-07-10 |