| NPI | 1952989105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 81357) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 9302) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2024-02-09 |