| NPI | 1841862166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 023263) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15842-I) |
| 363A00000X Physician Assistant (Licence: PR 001319-PA) | |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2023-09-05 |