| NPI | 1881125763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 15258) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 32499) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2024-09-12 |