| NPI | 1235704610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101027270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5151014984) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2024-07-08 |