| NPI | 1437731171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101283065) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101283065) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2026-08-27 |