| NPI | 1952854978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 93622) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2016022782) |
| 207Q00000X Family Medicine (Licence: MS 26298) | |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2023-08-26 |