| NPI | 1568213874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 91521) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL91521) |
| Enumeration Date | 2024-03-27 |
| Last Update Date | 2026-03-26 |