| NPI | 1295304103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2024028667) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2021024168) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2026-01-05 |