| NPI | 1760531859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-6624) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY m6624) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2023-04-07 |