| NPI | 1578002903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL acn1623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 14244-I) |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2025-03-17 |