| NPI | 1124760236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS20623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2023-03181) |
| Enumeration Date | 2022-04-09 |
| Last Update Date | 2025-07-18 |