| NPI | 1124656848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 341211) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 37762) |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2026-09-09 |