| NPI | 1437549763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-02311) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 279202) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2023-07-19 |