| NPI | 1316681232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101027462) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101027462) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2026-01-02 |