| NPI | 1396979217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-46955) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 45937) |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2024-01-11 |