| NPI | 1568437507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 046877) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2024-08-14 |