| NPI | 1356599443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 14438) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5315241305) |
| 207Q00000X Family Medicine (Licence: CA A109750) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2024-07-16 |