| NPI | 1033704226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023007981) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 20230079891) |
| Enumeration Date | 2021-03-09 |
| Last Update Date | 2024-07-26 |