| NPI | 1033806625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS21528) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO9083) |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2025-03-24 |