| NPI | 1710032271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-01049) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS9580) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2021-05-11 |