| NPI | 1598077216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 95625) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301097196) |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2025-09-29 |