| NPI | 1740987874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 24171) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 16336i) |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2024-11-21 |