| NPI | 1477782621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2010028285) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: MO 2010028285) |
| 207Q00000X Family Medicine (Licence: MO 2009018143) | |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2023-02-01 |