| NPI | 1265963938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-03321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 227060) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2026-03-10 |