| NPI | 1275238248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 89936) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL89936) |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2026-08-21 |