| NPI | 1730468299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0101272875) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: GA 040754) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2021-08-30 |