| NPI | 1053986059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 01861) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-2046) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2024-08-09 |