| NPI | 1720216955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 22227) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 3510) |
| 207Q00000X Family Medicine (Licence: MI 5101018229) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2022-03-07 |