| NPI | 1962971937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 21163) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21163) |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2023-07-30 |