| NPI | 1174086110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS18055) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 89415) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2025-01-21 |