| NPI | 1750571592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS011911) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2007004102) |
| 207Q00000X Family Medicine (Licence: TX K2593) | |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2023-11-05 |