| NPI | 1174789531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019009748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 173300-1205) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2024-02-06 |