| NPI | 1821491838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61108312) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 294985) |
| Enumeration Date | 2014-10-04 |
| Last Update Date | 2023-07-05 |