| NPI | 1417449695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 52233) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL52233) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2022-02-18 |