| NPI | 1235513466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA R-10440) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2019028550) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2026-01-14 |