| NPI | 1841873437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 74365) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR PG205152) |
| 207Q00000X Family Medicine (Licence: OR MD221871) | |
| 207Q00000X Family Medicine (Licence: CA 74365) | |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2024-10-24 |