| NPI | 1053523456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL 28606) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD 28606) |
| Enumeration Date | 2007-05-06 |
| Last Update Date | 2025-07-21 |