| NPI | 1700808854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 33231) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 042878) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2022-05-16 |