| NPI | 1679533491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-01003) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 19349) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2024-02-19 |