| NPI | 1225666175 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.45792) |
| Additional Taxonomies | 207QB0002X Family Medicine, Bariatric Medicine (Licence: AL MD.45792) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2025-02-07 |