| NPI | 1174185060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 44385) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T-3823) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2026-01-20 |