| NPI | 1336707918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301506810) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351045130) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2022-07-21 |