| NPI | 1881257343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MO 2024044855) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101025946) |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2025-01-17 |