| NPI | 1184070906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 218429) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2019-01453) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2023-05-19 |