| NPI | 1265851091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC MD51329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2019-00195) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2025-05-15 |