| NPI | 1437679842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 53392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL40965) |
| 207Q00000X Family Medicine (Licence: SC MD40965) | |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2023-05-03 |