| NPI | 1164318036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 82324) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 101793851) |
| Enumeration Date | 2025-06-16 |
| Last Update Date | 2026-08-26 |