| NPI | 1740316678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C2-0008161) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD H0100535) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2024-06-25 |