| NPI | 1326784257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1888) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-2167) |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2025-07-28 |