| NPI | 1942839824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 338692) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T-4262) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2024-07-15 |