| NPI | 1356791495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-03093) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 30328) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2024-01-23 |