| NPI | 1215613658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC LL90327) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 90327) |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2025-05-27 |