| NPI | 1376923573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019026367) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-44824) |
| 207Q00000X Family Medicine (Licence: AZ R75170) | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2024-04-30 |