| NPI | 1235192659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS5102) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 40316) |
| 207Q00000X Family Medicine (Licence: FL OS0005102) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2025-09-18 |