| NPI | 1184066045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 91153) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102203538) |
| Enumeration Date | 2013-07-20 |
| Last Update Date | 2026-07-14 |