| NPI | 1053847178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023010407) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-48852) |
| 207Q00000X Family Medicine (Licence: NE 31141) | |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2025-12-02 |