| NPI | 1447736491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 902780) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 134781) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2022-07-20 |