| NPI | 1477991925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2016023357) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD42863) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2019-12-31 |