| NPI | 1982347605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 88078) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL88078) |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2025-07-31 |