| NPI | 1649475963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 84226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101243977) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2024-07-17 |