| NPI | 1346866332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 79180) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME153221) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2026-01-02 |