| NPI | 1811139306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 341111) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 22441) |
| 207Q00000X Family Medicine (Licence: NM MD2018-0093) | |
| 207Q00000X Family Medicine (Licence: FL MF115184) | |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2024-09-04 |