| NPI | 1952592545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-01435) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-14797) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2024-05-07 |