| NPI | 1295756682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME44628) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL me001469) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: FL me001469) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2021-10-28 |