| NPI | 1043714405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 06038) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 012205817) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2025-09-09 |