| NPI | 1851056873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 70920) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 022884) |
| Enumeration Date | 2021-11-04 |
| Last Update Date | 2024-01-02 |