| NPI | 1104514082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102210165) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C7-0018189) |
| Enumeration Date | 2023-04-27 |
| Last Update Date | 2026-08-04 |