| NPI | 1508548538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023027749) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2023027749) |
| Enumeration Date | 2023-08-01 |
| Last Update Date | 2023-08-01 |