| NPI | 1306471685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 94161) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA unknown) |
| Enumeration Date | 2020-03-07 |
| Last Update Date | 2023-06-28 |