| NPI | 1780180935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS19090) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A18696) |
| 207Q00000X Family Medicine (Licence: KY TP928) | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2024-01-22 |