| NPI | 1598732315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R5G97) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR N6920) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2022-07-06 |