| NPI | 1679808638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.207797) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO DR51457) |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2024-02-12 |