| NPI | 1215163720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 5751321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101018141) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2023-11-14 |