| NPI | 1407435852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 7667) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 7667) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2025-01-29 |