| NPI | 1588613707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 4409) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 12048) |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2020-10-01 |