| NPI | 1023746757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 023937) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 342-P.A.) |
| Enumeration Date | 2022-08-10 |
| Last Update Date | 2024-07-30 |