| NPI | 1881952489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 23749) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.206534) |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2023-08-25 |