| NPI | 1902863509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0045155) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C10004236) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2023-08-30 |