| NPI | 1154996098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM DO2023-1087) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-2042) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2024-06-25 |