| NPI | 1154775500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0086614) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301116548) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2024-07-29 |