| NPI | 1578584421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 66576) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME64510) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2023-10-04 |