| NPI | 1972232759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 102756) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 13846) |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2025-08-04 |