| NPI | 1437713286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 67504) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME152434) |
| 207Q00000X Family Medicine (Licence: VI 3392) | |
| Enumeration Date | 2019-04-26 |
| Last Update Date | 2025-03-03 |