| NPI | 1902476211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-143848) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351048671) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2024-08-12 |