| NPI | 1295297430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 65915) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R77285) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2022-06-10 |