| NPI | 1750794616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS13849) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO 3902) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2021-08-19 |