| NPI | 1508093154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 1037) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: PR 17615) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2025-04-25 |