| NPI | 1760581888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME123648) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04 24112) |
| 207Q00000X Family Medicine (Licence: AL 39333) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2024-10-17 |