| NPI | 1487184255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 17087) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL14662) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2024-04-26 |