| NPI | 1386931483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ R72791) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4887) |
| Enumeration Date | 2011-07-09 |
| Last Update Date | 2025-03-25 |