| NPI | 1063943587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019003806) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-18327) |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2025-06-25 |