| NPI | 1932491867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME121800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301099013) |
| 207Q00000X Family Medicine (Licence: VA 0101258358) | |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2023-03-10 |