| NPI | 1235373135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301116455) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60287621) |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2023-10-04 |