| NPI | 1235707746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023045806) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2023045806) |
| Enumeration Date | 2021-06-12 |
| Last Update Date | 2025-06-17 |