| NPI | 1396064218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-01343) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101250609) |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2023-07-27 |