| NPI | 1184326688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 86974) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 86974-20) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-08-07 |