| NPI | 1740462548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: GA 060157) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 060157) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2024-04-01 |