| NPI | 1275763229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 2400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102202746) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2022-11-18 |