| NPI | 1568411643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 577) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 14064) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2021-05-14 |