| NPI | 1629119136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL os9601) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL OS9601) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2023-10-17 |