| NPI | 1285631515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C2-0000959) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2021-10-20 |