| NPI | 1982679262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101009514) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI JD009514) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2023-11-03 |