| NPI | 1396004222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 17259) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6668) |
| Enumeration Date | 2012-05-12 |
| Last Update Date | 2025-06-30 |