| NPI | 1386140135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 4415) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102206483) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2026-02-23 |