| NPI | 1083674766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 101542) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS0006004) |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2025-09-03 |