| NPI | 1295232684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 95482) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 98793) |
| 207Q00000X Family Medicine (Licence: MD D93248) | |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2025-10-31 |