| NPI | 1033734413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023034692) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL83229) |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2026-04-21 |