| NPI | 1801188933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-01861) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 24403) |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2023-12-29 |