| NPI | 1194090589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12760) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO2760) |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2023-09-18 |