| NPI | 1861897118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 18899) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 018899) |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2024-04-11 |