| NPI | 1184292096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 011735) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-12244) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2025-07-26 |