| NPI | 1447952783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS23212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 89891) |
| 208D00000X General Practice (Licence: SC 89891) | |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-08-28 |