| NPI | 1154307015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 10019) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 10019) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2024-03-01 |