| NPI | 1720055064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS0003594) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL OS0003594) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2022-11-23 |