| NPI | 1235960402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD AC006719) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE LG-0012838) |
| Enumeration Date | 2024-08-09 |
| Last Update Date | 2025-06-05 |