| NPI | 1356446447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 40616) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 00046836) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2024-03-27 |