| NPI | 1043704596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD222847) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 83812) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2025-06-23 |