| NPI | 1336133206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101263972) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 6368) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2023-10-28 |