| NPI | 1891177382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 7612) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: GA 80798) |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: GA 80798) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2024-08-21 |