| NPI | 1447945274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC LL89892) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC DO89892) |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2024-10-28 |