| NPI | 1467984138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 90500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2023050241) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2025-11-13 |