| NPI | 1760052906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 15695) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-12303) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2024-11-02 |