| NPI | 1215598537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 61186) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 4981R) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2025-11-25 |