| NPI | 1164984084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS022079) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR T20024-197) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2024-09-16 |