| NPI | 1700116605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 67041) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R71439) |
| 208D00000X General Practice (Licence: AZ 67041) | |
| Enumeration Date | 2009-12-28 |
| Last Update Date | 2025-05-23 |