| NPI | 1952838351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX U6449) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY 54170) |
| 208D00000X General Practice (Licence: FL ME139225) | |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2025-02-28 |