| NPI | 1184824187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME110808) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 58226) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2022-12-02 |