| NPI | 1154942068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 74622) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 13396876-1205) |
| 207Q00000X Family Medicine (Licence: NV 23975) | |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2025-02-25 |