| NPI | 1336928472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 11026127) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL APRN11026127) |
| Enumeration Date | 2023-09-27 |
| Last Update Date | 2023-09-27 |