| NPI | 1255679320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 3703) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 8132) |
| 207Q00000X Family Medicine (Licence: AZ 76081) | |
| Enumeration Date | 2013-01-24 |
| Last Update Date | 2025-05-08 |