| NPI | 1407296775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 302304) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T-2680) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2021-07-26 |