| NPI | 1700882776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: SC 13376) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 013376) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2025-08-20 |