| NPI | 1356057863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 8071360) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 390200000X) |
| Enumeration Date | 2023-01-27 |
| Last Update Date | 2025-05-29 |