| NPI | 1033806625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2026-00149) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO9083) |
| 207Q00000X Family Medicine (Licence: FL OS21528) | |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2026-08-17 |