| NPI | 1366416356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC MD38969) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 14527) |
| 207Q00000X Family Medicine (Licence: MA 238526) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2024-05-22 |