| NPI | 1245852409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301509187) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351046313) |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2024-07-02 |