| NPI | 1336321926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 2007-01685) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2007-01685) |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2022-08-23 |