| NPI | 1477817450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ R73472) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 006440) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2023-08-24 |