| NPI | 1477025591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 21690) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21690) |
| Enumeration Date | 2018-12-31 |
| Last Update Date | 2023-08-09 |