| NPI | 1598908824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME109715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 27218-R) |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2023-05-10 |