| NPI | 1366067639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 94487) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 11981) |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2023-07-06 |