| NPI | 1790487825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 89928) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 89928) |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2024-10-28 |