| NPI | 1073044343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-132637) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 6679) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2025-11-16 |