| NPI | 1013769173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC MMD.92269) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 92269) |
| Enumeration Date | 2024-04-03 |
| Last Update Date | 2025-10-13 |