| NPI | 1720080351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101012110) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101012110) |
| 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: MI 5101012110) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2023-02-09 |