| NPI | 1154942266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MI 4301509394) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351046347) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2023-12-30 |