| NPI | 1306539317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 7961867) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-2293) |
| Enumeration Date | 2023-05-26 |
| Last Update Date | 2026-07-17 |