| NPI | 1023543899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1206) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 104576) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2025-07-29 |