| NPI | 1477604544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 0063612) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101246692) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-10-01 |