| NPI | 1477044378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS21240) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 11368) |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2025-02-25 |