| NPI | 1386149391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 185188) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 146077) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2024-09-25 |