| NPI | 1356735823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR Pending) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 20140) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2023-08-02 |