| NPI | 1518317031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 63514) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10584) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2023-10-31 |