| NPI | 1699945451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 36684) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101243142) |
| Enumeration Date | 2008-03-08 |
| Last Update Date | 2024-08-23 |