| NPI | 1548062169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC MDO.94541LL) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC MDO.94541) |
| Enumeration Date | 2025-03-25 |
| Last Update Date | 2026-07-13 |